What is Severe COVID-19? How are you treated?

Coronavirus disease-19 (COVID-19) is caused by the SARS-CoV-2 virus. The infection is transmitted through close contact with the respiratory droplets. The main organs affected by COVID-19 include the lungs, heart, kidneys, genitals and liver.

severe Case of COVID-19 It has a relatively high mortality rate, including dyspnea. Even healthy people can experience severe COVID-19, but the risk of serious illness and death increases with age.

Severe illness is also more common in men compared to women. The risk of severe illness is high among certain ethnic groups, such as blacks and Hispanic individuals in the United States. Additional risk factors for the development of severe COVID-19 include cardiovascular disease, diabetes, immunosuppression, and obesity.

What is Severe COVID-19?

The most common early symptoms of COVID-19 include fever, cough, malaise, headache, muscle aches, and diarrhea. Statistically, 5% of symptomatological patients become seriously ill and 14% become severely ill. There is a big difference in the duration of symptoms and complications caused by COVID-19. Severe illness generally begins one week after the onset of symptoms.

Dyspnea (shortness of breath) is the most common symptom of severe COVID-19 and is found in 40% of symptomatological patients. Specifically, severe COVID-19 is diagnosed when the patient is experiencing the following:

• Respiratory rate of at least 30 breaths per minute
• Blood oxygen saturation of 93% or less
• Oxygenization index of 300mmHg
• Infiltrates more than 50% of the lung field on lung imaging

Dyspnea is usually associated with hypoxemia (hypoxemia). Many patients with severe COVID-19 also have progressive respiratory failure, lymphopenia, thromboembolic complications, and disorders of the central or peripheral nervous system.

Severe COVID-19 can lead to acute heart, kidney, and liver damage. Other complications include shock, cardiac arrhythmias, rhabdomyolysis (rapid destruction of damaged skeletal muscle), and impaired coagulation (impaired ability to form blood clots). Respiratory failure is the leading cause of death in COVID-19 patients, which is why respiratory assistance is the primary treatment.

How is severe COVID-19 treated?

COVID-19 can be diagnosed using:

• Patient’s medical history
• Detection of SARS-CoV-2 RNA in respiratory secretions
• Discovery of bilateral consolidation using chest radiographs

After diagnosis, the first step in the treatment of severe COVID-19 is hospitalization for careful monitoring. Patients are monitored in the intensive care unit by direct observation and pulse oximetry (a non-invasive test to measure oxygen saturation). Oxygen supplementation with a nasal cannula or Venturi mask is essential to maintain hemoglobin oxygen saturation between 90 and 96%.

The procedures currently used to treat COVID-19 include endotracheal intubation, extubation, bronchoscopy, airway suction, drug spraying, use of high-flow nasal cannula, non-invasive ventilation, and manual operation with a bag mask device. Includes ventilation. .. Patients receiving treatment for severe COVID-19 require proper nutrition and care to prevent further injuries.

According to current guidelines, clinicians should wear appropriate personal protective equipment (PPE), such as gloves, gowns, N95 masks, and eye protection, if there are patients with COVID-19. If possible, the patient should also wear a surgical mask to limit the spread of infectious droplets.

Determining when patients with severe COVID-19 should undergo endotracheal intubation is an important part of care. Intubation is performed by a skilled operator to insert a flexible plastic tube into the patient’s trachea to maintain an open and safe airway. The trachea (also called the trachea) is a large tube that allows the passage of air.

The patient requires pulmonary protective ventilation after intubation and requires a plateau pressure of 30 cm and a tidal volume based on the patient’s height. If the patient does not require intubation but has hypoxemia, a high flow nasal cannula can be used to improve oxygenation.

Medications such as sedatives and painkillers are often used to prevent pain, distress, and dyspnea in patients with severe COVID-19. Dexamethasone is a steroid that is currently considered the standard treatment for these patients. The drug reduces mortality in this group of patients who require oxygen, especially those who are given oxygen through a ventilator. Large clinical trials have shown that dexamethasone reduces the mortality rate of inpatients with COVID-19 who require oxygen supplementation by 17%.

Antiviral agent

Remdesivir has been approved by the Food and Drug Administration (FDA) for the treatment of Covid-19 in hospitalized patients, but more data is needed to understand its function in the treatment of severe COVID-19. .. Remdesivir appears to have an antiviral mechanism, as it has been shown to reduce the time it takes for patients to reach clinical recovery. The combination of dexamethasone and remdesivir is used more clinically, but its benefits require more research from clinical trials. Other antiviral drugs, such as lopinavir and ritonavir, have been tested for use against COVID-19.

Patients with COVID-19 can only be discharged from the intensive care unit and transferred to the department for treatment if certain criteria are met. These criteria are as follows:

• No fever for at least 3 days
• Major improvements in respiratory symptoms
• Chest scan showing reduction of lesions
• No life-threatening damage to major organs

To manage the high risk of complications from severe COVID-19, it is imperative to follow all infection control guidelines and quickly establish care goals for each patient.

reference:

Berlin, D. , Glick, R. , And Martinez, F. (2020). Severe Covid-19. New England Journal of Medicine, 383 (25), 2451-2460. Source: https: //www.nejm.org/doi/full/10.1056/NEJMcp2009575? query = featured_home

Xie, P., et al. (2020). Severe Covid-19: A review of recent advances in the future. Public Health Frontier, 8, 189. Source: https: //doi.org/10.3389/fpubh.2020.00189

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